耐碳青霉烯类肠杆菌科细菌菌血症影响因素分析

Influencing factors of bactericemia induced by carbapenem-resistant Enterobacteriaceae

目的通过对医院获得性(Hospital-accquired,HA)耐碳青霉烯类肠杆菌科细菌(Carbapenem-resistant enterobacteriaceae,CRE)菌血症感染特征的分析,筛选出影响其感染的影响因素。方法选取2018年1月-2019年6月河北医科大学第二医院收治的138例医院获得性肠杆菌科细菌菌血症患者。以CRE患者为病例组(22例),对碳青霉烯类药物(Carbapenem,CA)敏感的肠杆菌科细菌感染患者为对照组(116例),两组间按照年龄±2岁、性别相同进行1∶2个体匹配。最终共筛选19对病例对照进行Logistic回归分析。结果两组患者在入院次数、体质量指数(Body Mass Index,BMI)、入院天数、一种非CA抗菌药物使用时间和30天内连续高热天数间的资料是可比的。单因素分析结果显示,感染前留置中心静脉导管、感染前使用CA类药物、感染前使用二联非CA类药物、感染前住院时间>14天、感染前侵入性操作、感染前特级护理或一级护理和BMI<24 kg/m^2对HA-CRE菌血症感染有一定影响(P<0.20);多因素分析结果显示,感染前留置中心静脉导管、感染前使用CA类药物、感染前使用二联非CA类药物和感染前接受一级护理或者特级护理是影响HA-CRE菌血症感染影响因素(P<0.05)。病例组患者的死亡率(21.05%)高于对照组患者的死亡率(0.00%)(P<0.05)。药敏试验结果显示,病例组对替加环素全部敏感,两组均对庆大霉素(P=0.355)和磺胺甲噁唑/甲氧苄啶中度敏感(P=0.223),对氨苄西林高度耐药(P=0.424),对头孢呋辛舒巴坦中度耐药((P=0.208)。结论医院获得性CRE菌血症对替加环素全部敏感,应实时监测细菌耐药,多部门联合重视并规范临床碳青霉烯类药物和两种抗菌药物联合应用。

OBJECTIVE To analysis the characteristics of hospital-acquired(HA)carbapenem-resistant Enterobacteriaceae(CRE)bacteremia,so as to screen the risk factor of nosocomial infection.METHODS A tota of 138 hospitalized patients with Enterobacteriaceae bacteremia in the second hospital of Heibei Medical University from Jan.of 2018 to Jun.of 2019 were collected.Patients with CRE were selected as case group(22 cases),and patients with carbapenem sensitive Enterobacteriaceae nosocomial bacteremia were selected as control group(116 cases).The two groups were matched by 1∶2 individuals according to age±2 years old and the same gender.And finally 19 pairs of case controls were screened for Logistic regression analysis.RESULTS Data on admission,BMI,the duration of hospital stay,the days of carbapenem-use and the consecutive fever-day with 30 days before the infections of two groups were comparable.Univariate analysis showed that indweling central venous catheter before infection,use of the carbapenem and two non-carbapenem antibiotics before infection,hospitalization time>14 days,the invasive operation before infection,one grade nursing or intensive care and BMI<24 kg/m^2 were likely the risk factor of CRE infections(P<0.20).While multivariate analysis showed that indwelling of central venous catheter before infection,use of the carbapenem and two non-carbapenem antibiotics before infection and grade one nursing or intensive care were the independent risk factor of CRE infections(P=0.355).The mortality rate in case group was significantly higher than that in the control group(21.05%vs.0.00%,respectively)(P=0.223).The susceptibiligy test showed that the case group were all sensitive to tigecycline.Both groups were moderately sensitive to gentamycin and compound sulfamethoxazole and highly resistant to ampicillin(P=0.424),whereas moderately resistant to cefuroxime sulbactam(P=0.208).CONCLUSION Hospital-acquired CRE bacteremia were all sensitive to tigecycline.Surveillance should be part of a multimodal strategy to prevent and control CRE infection.And great efforts should be paid to standardizing the use of carbapenem and the combination of two antibiotics by multi-sectoral joint.